ArticleJournal of applied clinical medical physics2025
Patient setup variation on Elekta Unity and its impact on adaptive planning.
Article in Journal of applied clinical medical physics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Development and feasibility assessment of an automated, synthetic CT-guided plan selection system for bladder cancer adaptive radiotherapy: a retrospective pilot study.Translational cancer research · 2026Article
- Patient setup variation on Elekta Unity and its impact on adaptive planning.Journal of applied clinical medical physics · 2025Article
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10 authors.
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Abstract
purposeThe unique design of the MR-linac may restrict the use of effective immobilization devices, resulting in significant patient setup variations (PSVs). The purpose of this study is to analyze the PSVs on the Elekta Unity system and investigate their impact on adaptive planning.
methodsThe PSVs for 10 brain, 10 pancreas, five prostate, and five rectum patients previously treated on Elekta Unity were analyzed. The five prostate and five pancreas plans were selected to investigate the impact of PSVs on adaptive planning. The reference scans were shifted by 1, 2, and 3 cm in the left-right (LR) and superior-inferior (SI) directions to simulate PSVs. Both the adaptive-to-position (ATP) and adaptive-to-shape (ATS) workflows were executed. The adaptive planning time, number of monitor units (MUs), and dosimetric metrics quantifying target coverage and organ-at-risks (OARs) sparing were compared.
resultsFor brain treatments, the average/maximum PSVs were -0.2 ± 0.3 cm/0.8 cm (LR), 0.3 ± 0.7 cm/1.8 cm (SI), and 0.8 ± 0.7 cm/1.8 cm in the anterior-posterior (AP) direction. For pancreas treatments, the PSVs are -0.1 ± 1.0 cm/3.8 cm (LR), -0.1 ± 0.8 cm/3.5 cm (SI), and 0.3 ± 0.3 cm/1.3 cm (AP). Pelvis treatments had similar PSVs as pancreas treatments. The ATS workflow took two to three times longer than the ATP workflow. The only trend observed was that the plan MUs increased slightly (< 10%) with PSVs in the ATP workflow for prostate patients. Both workflows effectively reproduced target coverage and OAR sparing, regardless of the magnitude of the PSVs.
conclusionsSignificant PSVs were observed on Elekta Unity due to suboptimal patient immobilization. Using prostate and pancreas treatments as examples, we demonstrated that adaptive planning can effectively accommodate such PSVs. Nevertheless, efforts should be made to minimize PSVs-particularly rotations-to mitigate intra-fraction motion and reduce treatment time.
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